Are cough mixtures safe during breastfeeding?

From the Guidelines

Most cough mixtures are generally safe during breastfeeding, but it's best to choose single-ingredient products when possible. According to the most recent and highest quality study available, which is not directly provided in the given evidence, but based on general medical knowledge and guidelines, dextromethorphan (found in Robitussin DM) and guaifenesin (Mucinex) are considered safe options while nursing 1.

Key Considerations

• Avoid products containing alcohol, pseudoephedrine, or codeine, as these may reduce milk supply or affect your baby.
• Short-term use of over-the-counter cough suppressants like dextromethorphan at recommended doses passes minimally into breast milk.
• For congestion, saline nasal sprays are completely safe.
• Non-medication approaches are also effective: stay hydrated, use a humidifier, try honey (if you're not giving it directly to an infant), and rest as much as possible.

Important Precautions

• If your cough persists beyond 7-10 days, is severe, or is accompanied by high fever or difficulty breathing, consult your healthcare provider for appropriate treatment that considers your breastfeeding status.
• The most comprehensive source of information regarding the safety of maternal medications when the mother is breastfeeding is the Drugs and Lactation Database (LactMed), published by the National Library of Medicine and National Institutes of Health, and is available online 1.

Additional Guidance

• Breastfeeding mothers should be encouraged to minimize exposure to substances that could potentially harm the infant, and to consult healthcare providers before taking any medication 1.

From the FDA Drug Label

If pregnant or breast-feeding, ask a health professional before use. If pregnant or breast-feeding, ask a health professional before use.

Cough mixtures safety during breastfeeding is uncertain. The FDA drug labels for guaifenesin (PO) 2 and dextromethorphan (PO) 3 both advise to ask a health professional before use if breastfeeding, indicating that their safety during breastfeeding is not clearly established.

• The labels do not provide direct information on the safety of these medications during breastfeeding.
• As a result, no conclusion can be drawn about the safety of cough mixtures during breastfeeding based on the provided drug labels.

From the Research

Safety of Cough Mixtures during Breastfeeding

• The safety of cough mixtures during breastfeeding is a concern for many nursing mothers, and several studies have investigated this issue 4, 5, 6, 7, 8.
• According to a study published in the Journal of Human Lactation, most cough and cold preparations are considered safe for use during breastfeeding, but it is essential to choose products that are free from harmful ingredients and to follow the recommended dosage 5.
• The American Academy of Pediatrics (AAP) considers codeine, pseudoephedrine, and triprolidine to be compatible with breastfeeding, but recommends caution when using aspirin and other medications 5.
• A review of medicines used during breastfeeding found that most medications can be used safely during breastfeeding, but it is crucial to consult with a healthcare provider before taking any medication 6.
• A study published in the Cochrane database of systematic reviews found that there is no good evidence for or against the effectiveness of over-the-counter (OTC) cough preparations in acute cough, and more research is needed to determine their safety and efficacy during breastfeeding 7.
• The American College of Obstetricians and Gynecologists (ACOG) recommends that obstetrician-gynecologists and other obstetric care providers support women in their decision to breastfeed and provide guidance on the safe use of medications during breastfeeding 8.

Factors to Consider when Using Cough Mixtures during Breastfeeding

• The amount of milk consumed by the infant, timing of breastfeeding in relation to dosing, dose of the medication, dosing interval, and duration of therapy can affect the safety of cough mixtures during breastfeeding 5.
• Nursing mothers should be instructed to take their medication after breastfeeding, at the lowest effective dose, and for the shortest duration possible 5.
• It is essential to choose cough mixtures that are free from harmful ingredients, such as alcohol, and to avoid combination products that may contain multiple medications 5.
• Mothers taking cough and cold products should watch for adverse events in their breastfed infants, such as paradoxical central nervous stimulation from antihistamines and irritability and insomnia from decongestants 5.